Medicaid cuts affecting thousands of enrollees are already in motion, and more reductions are expected through the remainder of 2025 and into 2026. If you or someone in your household is currently on Medicaid — or recently lost coverage — understanding what is happening, why, and what programs may be available to you is the most important step you can take right now.

What Is Driving the Medicaid Reductions

The current wave of Medicaid enrollment losses stems from two overlapping pressures. First, the "unwinding" of continuous enrollment protections that were put in place during the COVID-19 public health emergency ended in 2023, triggering a nationwide redetermination process. Millions of people have already been disenrolled — many due to administrative reasons rather than actual ineligibility, such as outdated addresses or paperwork errors. Second, ongoing federal budget negotiations have introduced proposals to reduce federal Medicaid matching funds, impose per-capita caps, or add work reporting requirements. Some of these proposals, if enacted, could result in additional coverage losses for low-income adults, children, seniors, and people with disabilities.

The Centers for Medicare & Medicaid Services (CMS) administers Medicaid at the federal level, but each state operates its own program under federal guidelines. That means the specific impact of any cuts — and the alternatives available to you — will depend heavily on where you live.

Who Is Most at Risk of Losing Medicaid Coverage

Low-Income Adults in Expansion States In the 40 states (plus Washington, D.C.) that adopted Medicaid expansion under the Affordable Care Act (ACA), adults with household incomes at or below 138% of the Federal Poverty Level (FPL) are generally eligible. Proposed federal changes targeting expansion funding could affect this group most directly.

Children and Families The Children's Health Insurance Program (CHIP) covers children in households with incomes generally between 138% and 300% FPL, though thresholds vary by state. CHIP is jointly funded by states and the federal government, and any reduction in federal matching rates could pressure states to tighten eligibility or reduce benefits.

Seniors and People with Disabilities on Dual Coverage Individuals who are enrolled in both Medicare and Medicaid — known as "dual eligibles" — rely on Medicaid to cover costs that Medicare does not, including long-term care, dental, and vision. This population faces particular risk if states reduce optional Medicaid benefits.

People Disenrolled for Administrative Reasons If you received a notice that your Medicaid was terminated, do not assume you are ineligible. A significant share of disenrollments during the unwinding process were due to procedural issues. You may have the right to appeal, and you may still be eligible to re-enroll.

What to Do If You Lose Medicaid Coverage

Step 1: Check Your Eligibility to Re-Enroll Contact your state Medicaid agency directly or visit your state's Medicaid portal. Bring documentation including proof of income (pay stubs, tax returns, or a letter from your employer), proof of residency, Social Security numbers for all household members, and proof of citizenship or immigration status. If you were disenrolled in error, you have the right to request a fair hearing.

Step 2: Apply for ACA Marketplace Coverage During Your Special Enrollment Period Losing Medicaid qualifies as a life event that triggers a Special Enrollment Period (SEP) on the ACA Health Insurance Marketplace (HealthCare.gov or your state's exchange). You generally have 60 days from the date you lose coverage to enroll. Households with incomes between 100% and 400% FPL — and in some cases above — may be eligible for Advanced Premium Tax Credits (APTCs) that significantly reduce monthly premiums. Benefit amounts vary by household size and income.

Step 3: Find a Federally Qualified Health Center (FQHC) FQHCs are community health centers funded by the Health Resources and Services Administration (HRSA) that are required by law to serve patients regardless of their ability to pay. They use a sliding fee scale based on income. You can locate the nearest FQHC using the HRSA Health Center Finder at findahealthcenter.hrsa.gov. These centers provide primary care, dental, mental health, and substance use services.

Step 4: Explore Prescription Assistance Programs If you lose Medicaid drug coverage, several programs may help: - NeedyMeds (needymeds.org): A nonprofit database of patient assistance programs, drug discount cards, and disease-specific programs. - RxAssist: A directory of pharmaceutical manufacturer Patient Assistance Programs (PAPs), which may provide free or low-cost medications to qualifying individuals. - Extra Help (Low Income Subsidy): If you are enrolled in Medicare Part D, you may be eligible for the Extra Help program through the Social Security Administration (SSA), which helps cover prescription drug costs for people with limited income and resources.

Required Documents for Medicaid and Marketplace Applications

Whether you are reapplying for Medicaid or enrolling in a Marketplace plan, gather these documents before you begin: - Government-issued photo ID - Proof of income for all household members (recent pay stubs, employer letter, or most recent federal tax return) - Social Security numbers or immigration documentation - Proof of current address (utility bill, lease agreement, or bank statement) - Information about any current health insurance coverage

State Variation Is Critical to Understand

Medicaid eligibility thresholds, covered benefits, and the specific impact of any federal changes vary significantly from state to state. A household that qualifies for Medicaid in a Medicaid expansion state may not qualify in a non-expansion state. CHIP income limits, covered services, and cost-sharing requirements also differ. Always verify your specific state's rules through your state Medicaid agency or Benefits.gov.

A Clear Next Step

If you have received a Medicaid termination notice, lost coverage recently, or are concerned about upcoming changes, the most actionable step is to contact your state Medicaid agency within 30 days of any notice — sooner if possible. If you are unsure where to start, a licensed navigator or certified application counselor can help you understand your options at no cost. Navigators are available through HealthCare.gov and many community health organizations.

Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: April 2026